Provider Demographics
NPI:1730425141
Name:BRILLANT, MARIA THERESA (NP)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:THERESA
Last Name:BRILLANT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:NJ
Mailing Address - Zip Code:07848-4400
Mailing Address - Country:US
Mailing Address - Phone:973-300-0253
Mailing Address - Fax:
Practice Address - Street 1:545 1ST AVE
Practice Address - Street 2:GREENBERG HALL C-124
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6401
Practice Address - Country:US
Practice Address - Phone:212-263-5651
Practice Address - Fax:646-754-9579
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305863363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health